Why do we love our pills so much?
Updated: Apr 8, 2020
Hitesh was a successful 45-year-old executive. He had been feeling down in the dumps, depressed, almost hopeless for the past few months. Finally, he gathered the courage to visit a psychiatrist after multiple second thoughts and at the encouragement of his wife.
The psychiatrist listened to his symptoms, diagnosed mild depression, and prescribed anti-anxiety medication. Now, would you imagine the doctor prescribing exercise rather than the medication? No? You should.
The efficacy of exercise in decreasing symptoms of depression has been well-established in a large number of studies. One study showed over the course of four months, that exercise was as effective as medication (sertraline in this example, a commonly prescribed anti-depressant) for reducing symptoms of depression. Follow-up of the same patients at 10 months revealed that the exercise group members had lower rates of depression than those on medication.
Would you imagine the doctor asking for magnesium testing? Its deficiency is a known risk factor for depression.
Similarly, the evidence-base for the effectiveness of cognitive behavioral therapy (CBT) is very strong for depression and other mental disorders. 
What would you have prescribed as the first step if you had this knowledge: medication or exercise+CBT?
So, in the example above, who is at fault? The doctor? The doctor, who has a long line of patients waiting outside his door and would find it more efficient to write medication on a piece of paper and send the patient on his way, rather than spending time on explaining the how/what/when of exercise/LSM? The doctor, who knows that most patients expect to receive a prescription of medication, and just a discussion around exercise and talk therapy wouldn’t satisfy them, nor would it be appreciated, nor considered money well-spent? Doctors who know the whole system of therapy is oriented towards drugs, and do not feel able to swim against that tide? Doctors who are also technically trained to manage the disease, not prevent, or cure the cause?
So basically, the doctors are either not aware, or overworked, or know that the patient compliance for lifestyle therapy would be very low.
Is it the patient's fault? If the doctor prescribed a daily regimen of 30 minutes of exercise and regular one-hour sessions of CBT, what are the chances of Rajiv above being compliant, vs popping a few pills daily, which require only a fraction of a minute? And though we all know that medications could have side effects, and that long-term use of medication vs long-term exercise can have very different implications on the body, what would most people practically do? Or want to do? What would you do?
A majority of the patients wouldn’t be interested in hearing that they are sedentary, or they eat poorly; people don’t want to hear that their choices are poor, and that they need to change their habits and their behavior. Some other examples that we see daily: people consume alcohol day-in and day-out despite repeated warnings from their doctor, and when they develop liver cirrhosis years later, they again approach the same doctors, expecting some magical cure. Now they do not have any option other than a liver transplant. Many wouldn’t be able to afford it, and even for those who could, the results wouldn't be that promising. The same story goes for smoking, and its multiple life-threatening complications. The same story is repeated time and again, for diabetes, heart disease, obesity ... you name it. We know the problem, we know the cure, but we do not adopt it; and then, when it's too late, we run around in desperation, looking for that magical cure that isn't there.
Our world places very little value in prevention. It seems so vague, so flighty, the results sound so unclear that people’s belief in it is just as vague, as uncertain. Even if they were given facts that lifestyle modification can provide them both symptomatic relief as well as can reverse/halt the disease, many would be too happy to continue taking pills rather than doing the hard work. Science does not translate into change in behavior, not this easily.
Not to mention, pills provide immediate symptomatic relief, while LSM requires time and patience to show effects. Weight gain, metabolic changes, chronic inflammation, these develop over years of body abuse. Reversing the process would require at-least months, if not years. In this world of instant gratification, with pills requiring much less effort on the patient’s part, who would be the winner? I have heard cardiologists going on record that when patients were advised with respect to lifestyle changes, the response was that they were ready to take few more pills/day rather than putting in any effort. What they do not realize is, all the pills in the world did not have the kind of power LSM had to modify the course of their disease.
And then there is the world of pharmaceutical and device industries, worth billions and billions of dollars. It’s a big world out there, and who will suffer financially if usage of medications goes down? There is no money to be had from healthy people. There is no money to be had from dead people. However, years and years of medication and interventions required in chronic diseases generate piles and piles of good, ol’ cash.
The result is this:
So, it’s the combination of the doctors, the patients, and the commercial world, that has brought us into an era where our kids might end up having a lower life expectancy than us, for the first time in history.
Does that mean we are doomed? Only if we do not take any step, only if we just sit back and do nothing to change our bodies and our genes, for our sake and for the generations to come.
The first step: a huge change in our collective mind-set, a paradigm shift, is required. We can’t do much about the industry, but we can change ourselves, both as doctors and as patients, to acknowledge the importance of lifestyle medicine and preventive health intervention in ensuring that we live up to a ripe old age, not weak or disabled, but fit and full of energy.
07 October 2019